Provider Demographics
NPI:1427309079
Name:CERISIER, SUZE IV (OTA)
Entity type:Individual
Prefix:MRS
First Name:SUZE
Middle Name:
Last Name:CERISIER
Suffix:IV
Gender:F
Credentials:OTA
Other - Prefix:MRS
Other - First Name:SUZE
Other - Middle Name:
Other - Last Name:CERISIER
Other - Suffix:IV
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:1537 E 57TH ST
Mailing Address - Street 2:1537 EAST 57 STREET
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4024
Mailing Address - Country:US
Mailing Address - Phone:718-344-1119
Mailing Address - Fax:
Practice Address - Street 1:1537 E 57TH ST
Practice Address - Street 2:1537 EAST 57 STREET
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4024
Practice Address - Country:US
Practice Address - Phone:718-344-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-23
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007005-1283XC2000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No283XC2000XHospitalsRehabilitation HospitalChildren